14th International Congress
THE "NEW FRONTIERS"
OF ARRHYTHMIAS 2000

Jan. 29 - Feb. 5, 2000
Marilleva, Trento, Italy

RT-127

Ventricular tachycardia in Chagas’ heart disease

Ivan Mendoza, Federico Moleiro, Juan Marques, Francesca Misticchio, Alvaro Matheus, Freddy Rodríguez, Ivan Mendoza Britto, Julio Guerrero, Agustin Castellanos.
Section of Cardiology, Tropical Medicine Institute, Central University of Venezuela, Caracas, Venezuela, Memorial Hospital, University of Miami, Miami, USA

Abstract

Chagas’ heart disease is an important problem of public health affecting 20 million people in Latin America. The transmission of Chagas’ disease via blood transfusion is not confined to countries where the disease is endemic. The migration of persons infected by trypanosoma cruzi poses a public health problem even for the United States and Europa where the disease is not transmitted by vectors. Chagas’ heart disease is one of the leading causes of sudden death after coronary artery disease. Approximately, half of the patients with the diagnosis of Chaga´s disease die suddenly.

The severity of ventricular arrhythmias tends to correlate with the degree of left ventricular dysfunction. However, it is not uncommon to have patients with ventricular tachycardia who have well preserved global ventricular perfomance. Ventricular arrhythmias of Chagas’ heart disease are one of the most demanding models on which an antiarrhythmic drug can be tested. Proarrhythmia is common. Conventional antiarrhythmic agents except amiodarone, may increase the risk of ventricular fibrillation, or agravate a preexistent cardiac failure. A new syndrome is reported in patients with Chagas’ disease with the following characteristics: 1. right bundle branch block; 2. ST segment elevation in right precordial leads; 3. sustained or nonsustained right ventricular outflow tract tachycardia; 4. In some chagasic patients this electrocardiographic pattern can be evoked by ajmaline or performing high right precordial leads or right chest traditional leads. Prevention of arrhythmic death is an important but elusive goal of treatment.

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